You had the foresight to purchase long term disability insurance benefits to replace your lost income if you cannot work due to an injury or disabling medical condition. You’ve consistently paid your disability insurance premiums month after month, year after year, or even decade after decade. You suffer a debilitating injury or develop a disabling medical condition that keeps you from being able to work consistently. You may have even been approved for Social Security Disability Insurance benefits. Despite your inability to work, you receive a disability insurance claim denial letter from Unum Group.
The last thing you ever imagined or want to hear is that the insurance company you’ve been paying has decided not to approve your disability claim. That means the carrier has refused to pay you the long term disability benefits that you are entitled to under your LTD policy. Unfortunately, Unum has a history of poor claims handling procedures and denying claims, but a Unum disability lawyer can help.
Unum Disability Insurance Claims Are Often Denied
Unum, also known as Unum Group, has acquired and taken over all long term disability policies issued by Provident Life and Accident, Unum Provident, First Unum Life, Colonial Life & Accident Insurance, and The Paul Revere Life Insurance Company. Unum is one of the largest disability insurance carriers in the industry, offers both group disability and individual disability insurance policies, and has a long history of denying disability insurance claims in bad faith.
Unfortunately, this happens all too often. Unum denies legitimate disability insurance claims, leaving the claimants without the very benefits they thought would be there in their time of need. Long term disability claimants are left scrambling to figure out how to pay for their food, shelter, and other monthly bills, and wondering how they will support their families.
If your Unum disability claim has been denied, know that you are not alone. Unum has a history of denying legitimate disability claims. The following is a clip from the news investigation program, 60 Minutes, which did a piece on the Unum disability claim process:
Many individuals with a Unum disability insurance claim need to hire an experienced disability lawyer to oversee claims handling and to help them fight for their disability benefits.
With over a decade of experience representing the disabled in disability benefits claims across the United States, the experienced disability insurance lawyers at Ortiz Law Firm have the skill and insight needed to help you address a wide range of issues relating to disability law and Unum disability claims.
The Ortiz Law Firm typically gets involved in a disability benefits claim once it has been denied or terminated, so this article and the video below will focus on denied Unum disability claims.
Was Your Unum Disability Insurance Claim Denied?
There are many reasons why an insurance company denies disability claims, especially claims for long term disability benefits. Below are several reasons Unum may have denied your claim, each sourced from Unum long term disability claim denials handled by our firm.
Top Reasons Why Unum Denies Disability Claims
Unum Had Your Claim Reviewed by One of Their Physicians in a Peer-Review Evaluation
Your denial letter might say, “to give your file every consideration, two physicians reviewed the medical documentation in your claim. The review does not find that you have been precluded from your occupational demands on a full-time basis.”
That means Unum sent your medical records to one of their doctors, and their doctor has given an opinion as to what you can and can’t do. The insurance company says they think you could go back to work based upon that doctor’s opinions, even though that doctor has never seen or examined you.
Unum Determined You Were Not Continuously Disabled Through Your Elimination Period
Your denial may state that, “Your policy requires that you be continuously disabled for a period of 180 days before benefits become payable. Our review does not find that you were continuously disabled “Most disability insurance policies require that you be disabled for a specific amount of time before you are eligible to receive benefits. Let’s look at a policy from one of our past cases:
Elimination Period means a period of continuous disability which must be satisfied before you are eligible to receive benefits from Unum.
You must be continuously disabled through your elimination period. Unum will treat your disability as continuous if your disability stops for 30 days or less during the elimination period. The days that you are not disabled will not count toward your elimination period.
Your elimination period is 180 days.
You are not required to have a 20% or more loss in your indexed monthly earnings due to the same injury or sickness to be considered disabled during the elimination period.
Source: A Hartford Denial Letter
Unum Ordered a Vocational Analysis of Your Claim
Your letter may state, “we had your file reviewed by our Vocational Specialist to assess the occupation duties of your own occupation.” What that means is that the disability insurance company sent your file to one of their job experts and their job expert says that based upon a review of your file that you can return to work in some capacity.
Unum Says There is Insufficient Medical Evidence
They may say that “we don’t think that the evidence in your medical records shows that you’re unable to perform your job or maybe any other job in the economy.”
There’s a Change in the Definition of Disability
Most long term disability policies have two definitions of disability, one for the “own occupation” period and one for the “any occupation” period. This typically occurs after 24 months where they may have approved your case while saying you cannot do the material duties of your job, which is your individual occupation. But they may say that you can do other types of work, meaning that you could do any occupation. So if Unum terminated your claim after two years, then you may have the right to appeal that as well.
Unum Limits Payments if You Are Unable to Work Due to a Mental Health Disorder
Most disability insurance companies will only pay long term disability claims related to mental health problems for a limited amount of time (typically after benefits are payable for 24 months), but your benefits should continue if you also have physical conditions that prevent you from working. Unum will try to say your physical conditions are not disabling so it can justify the claim denial.
If you filed your claim on your own and received notice that UNUM has denied your long term disability insurance claim, regardless of the specific reason for the denial, it is strongly recommended that you do not proceed through the appeal process without first requesting a case review by an attorney.
How a Unum Disability Lawyer Will Help You Obtain Benefits
Our goal is to document your disability in a manner that clearly demonstrates your impairments and your qualification for benefits. We will work with you to gather the appropriate evidence and documentation to satisfy the requirements of your disability plan and will work diligently to address any purported deficiencies Unum found with your documentation and paperwork as we prepare to appeal the claim denial.
We will also prepare questionnaires for your medical providers that are customized to your disabling conditions (also known as an Attending Physician’s Statement or a Medical Source Statement). Unum may provide you with a generic Attending Physician’s Statement form, but this form is designed to apply to every claim whether the claimant is suffering from a heart condition or a broken ankle. The limitations and restrictions for someone with a heart condition are entirely different from the limitations and restrictions for someone with a broken ankle, so using a form that only asks about the limitations and restrictions that apply to you will make it much easier for your doctor to complete the form.
In some cases, we are successful in having Unum put the claimant “on claim”, which means that the claim was approved and benefits were paid during the internal appeals process with Unum’s claims department without resorting to a lawsuit against the insurance carrier. In other instances, however, Unum may continue to deny your claim.
Do I Have to File an Appeal Before I Can I File a Lawsuit Against Unum Life Insurance Company?
Whether you have to file an appeal before filing a lawsuit depends on how you obtained your disability policy. Many insurance companies offer both group and individual disability insurance policies. The type of policy you have will determine what steps you can take if your claim is wrongfully denied. Your legal rights with a Unum group insurance policy are very different from your legal rights with an individual policy.
Individual Disability Coverage vs. Group Disability Coverage
If your Unum policy is part of a group benefits plan through a private employer, employee organization, or union, then it is likely governed by ERISA, and you will have to file at least one appeal before suing the Unum insurance company. Should the internal appeals process fail, you have the right to file an ERISA lawsuit to have your case reviewed by a federal judge. Under ERISA, the disability insurance company has no exposure to bad faith damages and thus has no real incentive to pay the claim.
It is almost always better to have an individual policy rather than a group policy. If you have an individual policy, or if your policy is provided by a church or a government employer, then your claim is likely not governed by ERISA, and you may not have to file any appeals before filing a lawsuit. Bad faith damages also come into play, as bad faith laws apply only if ERISA regulations do not apply.
If you’ve exhausted your appeals, or if you’re trying to determine if you have to file an appeal, we are here to help. We will you file a lawsuit against the insurance company, and prepare all necessary documentation for the court review process.
Work With an Experienced Unum Disability Insurance Attorney
At the Ortiz Law Firm, we understand how frustrating it can be to receive a disability claim denial. Mr. Ortiz is an experienced disability attorney who has worked with numerous clients who have received claim denials from Unum claims representatives. Some claimants are denied from the initial application, while others receive benefit cessation letters – which means their benefits are being “cut-off” or terminated. Either way, we are here to help.
The experience we have gained while helping past clients fight insurance companies like Unum has given us great insight into the best steps to take to improve your chances of recovering benefits against Unum and any other insurance companies. We also handle Social Security Disability claims, so if you have a concurrent claim with the SSA, we can assist you with that case as well.
Request a Free Legal Consultation
Contact us online or call (866) 853-7756 to request a free consultation with one of our experienced disability lawyers to discuss your Unum claim and learn how we can help you fight for the denied disability benefits you deserve. The free consultation is an opportunity to discuss the specific details of your disability denial with our insurance lawyers, and there is no obligation to retain our firm.